A B.C. Nurses’ Union executive says the new pay-for-performance funding model being tested at select Vancouver-area hospitals is having a “negative effect” on the health-care system.
Len Rose, an executive councillor for the union and a nurse of 17 years, told the Straight that the pilot project “leads to almost an assembly-line aspect of patient care”.
Since late 2007, the provincial government has funded four hospitals—Lions Gate, St. Paul’s, Richmond, and Vancouver General—according to the number of procedures performed in the facilities, rather than through an annual operating budget. The goal of the pilot is to see if financial incentives lead to improved patient flow and faster access to health care.
“We’ve got a system that couldn’t handle the patient flow that we had two years ago,” Rose said. “And now we’re trying to speed it up.”
The model has shortened wait times for more than 25 percent of emergency-department patients, according to Vancouver Coastal Health.
Anna Marie D’Angelo, spokesperson for the regional health authority, said the approach “is working out really well”. D’Angelo told the Straight, “It’s not made any more work for them [doctors and nurses]. It’s actually more efficient. So it’s worked out well for everybody.”
At North Vancouver’s Lions Gate Hospital, 57 percent of patients needing to be admitted are being placed in a bed within 10 hours, up from 39 percent in 2007. The number of urgent cases being turned around in less than two hours has gone from 29 percent to 51 percent.
However, Rose asserted it’s a classic case of quantity over quality. Although turnaround times have quickened, he argues that’s not a good thing. “Even though it’s speeding up the flow of patients through emergencies, what it’s leading to is even more congestion on the hospital wards and floors,” Rose said.
With doctors and nurses rushing to meet deadlines, patients are ending up in what Rose called “hallway or bathroom nursing”. In some cases, he said, patients are being discharged and given a referral for community home-care nursing.
Rose fears that hospitals may modify certain practices and cut corners to maximize earnings. Financial incentives received under the pay-for-performance model do not go to individual physicians or other staff, but to the hospitals for reinvestment.
“The other fear for me and for the nurses’ union is that this is going to lead toward full privatization in health care,” Rose said.
According to Rose, the nurses’ union is working with the B.C. Health Coalition’s Friends of Medicare Campaign to “ensure the fee-per-patient service is not going to spread, unless they actually prove themselves and have it done completely in the public system”.
New Brunswick health minister Mike Murphy announced in January his intention to put so-called patient-based funding into practice in his province. Quebec is also considering similar reform.
In August, delegates to the Canadian Medical Association’s annual general council in Montreal approved a resolution sponsored by incoming president Dr. Robert Ouellet, a proponent of the pay-for-performance model, calling on the CMA to develop a plan by February 2009 for the transformation of the health-care system through patient-based funding.source
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